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ASCO Patient Guide: Sentinel Lymph Node Biopsy in Early Stage Breast Cancer
Introduction
To help doctors give their patients the best possible care, ASCO asks its medical experts to review the latest research on issues in cancer care and develop recommendations called clinical practice guidelines. ASCO recently developed a new clinical practice guideline for the use of sentinel lymph node biopsy (SNB) in early stage breast cancer. To help people living with cancer understand their cancer care, ASCO created this patient guide, which is based on ASCO's guidelines for the use of SNB.
As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your or your doctors' judgment. The final decisions you and your doctors make will be based on your individual circumstances.
Information in ASCO's patient education materials is not intended as medical advice or as a substitute for the treating doctor's own professional judgment; nor does it imply ASCO endorsement of any product or company.
Last Updated: September 12, 2005
About SNB
SNB is a procedure where one or a few lymph nodes are removed from under the arm and examined for evidence of cancer. When cancer spreads from the breast, it travels through the lymphatic system into lymph nodes, which are tiny, bean-shaped organs that fight infection and disease. The first lymph node or group of lymph nodes encountered is called the sentinel node. In most patients, if no evidence of cancer is found in the sentinel node, it can be expected that no cancer will be found in the remaining axillary lymph nodes. Knowing whether the cancer has spread helps determine the stage and approach to treatment. That is, cancer that has spread to the lymph nodes may be treated differently than cancer that has not spread to the lymph nodes.
To locate the sentinel node, the surgeon injects a weak, harmless, radioactive substance and/or a blue dye into the breast near the tumor. Then, the surgeon makes an incision under the arm and either follows the radioactive signal or finds the lymph nodes that are stained blue and removes them. Usually, between one and three nodes are removed. A pathologist (a medical doctor who specializes in examining tissues) then carefully examines the sentinel node(s) for evidence of cancer.
Last Updated: September 12, 2005
Axillary lymph node dissection
Another way of evaluating lymph nodes is with an axillary lymph node dissection. During this procedure, most lymph nodes under the arm (generally 20 to 25) are removed and examined for evidence of cancer. Because more lymph nodes are studied, the doctor may have more evidence of whether the cancer has spread. However, this procedure can result in long-term complications or disabilities, including pain and numbness in the arm and lymphedema (excess fluid in the arm that causes swelling). Some patients may also experience side effects from SNB, but these are usually milder than the side effects experienced after an axillary lymph node dissection.
Last Updated: September 12, 2005
Recommendations
ASCO has issued the following recommendations regarding the use of SNB:
- SNB can be used instead of axillary lymph node dissection for many patients with early stage breast cancer and no clinically suspicious lymph nodes (usually meaning that the doctor cannot feel them during an examination).
- If the results of the SNB show no evidence of cancer, and an experienced surgeon has done the procedure, an axillary lymph node dissection is not needed. Experience generally means that a surgeon has performed this procedure many times with correct results.
- If the results of the SNB show evidence that the cancer has spread, then axillary lymph node dissection is recommended.
Last Updated: September 12, 2005
What this means for patients
For many patients with smaller tumors, SNB is an appropriate procedure to determine whether cancer has spread outside of the breast and can be performed instead of an axillary lymph node dissection. SNB is associated with fewer long-term side effects than axillary lymph node dissection. However, it is not yet known whether SNB affects long-term survival in patients with breast cancer.
However, patients with larger tumors or clinically suspicious lymph nodes should have an axillary lymph node dissection instead of SNB. In addition, if the results of the SNB are positive for cancer, then a complete axillary lymph node dissection is needed to determine how far the cancer has spread. Talk with your doctor about whether SNB is an option for you.
If the results of the SNB show that the cancer has not spread, an axillary lymph node dissection is not needed, as long as an experienced surgical team performed the procedure.
Last Updated: September 12, 2005
Questions to ask your doctor
Cancer treatment decisions can be complex. Consider asking your doctor the following questions:
- Am I a good candidate for SNB? Why or why not?
- Do you recommend an axillary lymph node dissection instead? Why or why not?
- What are the risks of the procedure you recommend?
- Can you recommend an experienced surgeon to perform this procedure?
- When will I know the results?
- Will you explain what they mean?
- What is the next step if the test results are positive?
- What is the next step if the test results are negative?
- What follow-up care will I need after the procedure?
- Will I have a surgical drain after surgery?
- What can I expect in terms of range of motion in my arm?
- Will I need to do daily exercises after surgery?
- Where can I find more information?
Last Updated: September 12, 2005
Helpful links and resources
Read the entire clinical practice guideline published in the Journal of Clinical Oncology (JCO)
Q&A: Sentinel Lymph Node Biopsy
Cancer.Net Feature: Sentinel Lymph Node Biopsy
Resources
Cancer.Net (www.cancer.net) is the comprehensive, oncologist-approved cancer information website from ASCO. Visit Cancer.Net to find guides on more than 85 types of cancer, clinical trials information, coping resources, information on managing side effects, a live online chat series, medical illustrations, cancer information in Spanish, the latest cancer news, and much more. For more information about ASCO's patient information resources, call toll free 888-651-3038.
American Cancer Society
1599 Clifton Rd., NE
Atlanta, GA 30329
Phone: 800-ACS-2345 (800-227-2345)
www.cancer.org
Breastcancer.org
111 Forrest Ave. 1R
Narberth, PA 19072
www.breastcancer.org
CancerCare
275 7th Ave.
New York, NY 10001
Phone: 800-813-HOPE (800-813-4673)
www.cancercare.org
National Cancer Institute
NCI Public Inquiries Office, Ste. 3036A
6116 Executive Blvd., MSC8322
Bethesda, MD 20892-8322
Phone: 800-4-CANCER (800-422-6237)
www.cancer.gov
Oncolink
Abramson Cancer Center of the University of Pennsylvania
3400 Spruce St.
2 Donner
Philadelphia, PA 19104-4283
Fax: 215-349-5445
www.oncolink.com
The Susan G. Komen Breast Cancer Foundation, Inc.
5005 LBJ Freeway
Ste. 250
Dallas, TX 75244
Phone: 800-IM-AWARE (800-462-9273)
Phone: 972-855-1600
Fax: 972-855-4300
www.komen.org
Last Updated: September 12, 2005
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